Why is the advice for treatment of the menopause so confusing?

In the midst of conflicting information surrounding HRT and the best ways to treat the symptoms of the menopause, author of The Menopause Maze, Liz Efiong – inspired by recent media inspection of the issue – weighs in.

Last year, Dr Megan Arroll and I published a book for women approaching and experiencing menopause entitled The Menopause Maze: The Complete Guide to Conventional, Complementary and Self-Help Options. We set out to write a book which would inform and empower women to visit their GPs and seek the help they needed. Our book was published after the National Institute for Health and Care Excellence’s (NICE) new guidelines at the end of 2015 and presents the very latest advice from menopause experts.

On the 23rd of February 2017, an hour long documentary called The Insiders’ Guide to the Menopause, became available on BBC iPlayer*. The programme was presented by Kirsty Wark, who herself went through the menopause following a hysterectomy and took HRT for 3 years until stopping abruptly in 2002, when the health scares surrounding the study called the Women’s Health Initiative (WHI) were published. The results showed an increased risk of breast cancer for women taking HRT, which caused many women to stop taking HRT suddenly, often going cold-turkey without even consulting a medical professional. Women stopped asking their GPs for HRT, whilst GPs were also caught up in the safety issues and became less familiar with HRT.

As the programme very rightly pointed out, some GPs can be unsympathetic and if women don’t get an answer the first time they visit their GP, they then often don’t feel confident to go back a second time and many suffer in silence. Although subsequent research suggested that the results from the WHI study were flawed, the positive appraisals received nothing like the same publicity as the original scare.

Dr Heather Currie, Chairman of The British Menopause Society and Associate Specialist Gynaecologist at Dumfries and Galloway Royal Infirmary, Scotland, said ‘we really, really need to talk about it [the menopause] more’ and that diet and lifestyle changes are really important too. She adds that ‘the feeling now is that for women who are having menopausal symptoms – for most women – the benefits of HRT outweigh the risks’.

At the end of the programme, Kirsty said she ‘may revisit taking HRT’. But what are the risks and benefits and what does ‘flawed data’ mean? How do women know who to trust? Many believe that the subsequent positive data is sponsored by the pharmaceutical industry and believe that the risks outweigh the benefits.

In our book, we explain WHY the results of the WHI Study were flawed and give women something to take to their GP, based on up-to-date research. We also cover basic principles for the health of the menopausal woman and beyond including dietary and environmental factors, supplements and herbs, reducing stress levels, complementary therapies, self-help techniques, HRT and other prescribed medications (including bioidentical, or body-identical, hormones), and pull everything together in the final chapter.

‘Where the book is cutting edge is in the balanced, critical discussion on the use of HRT, and bioidentical hormone therapy as well as non-hormone medical treatments and medical tests. Don’t wait for the menopause; be informed and make the most of the next empowering phase of your life’ (Heather Rosa fBANT fHEA)

‘In summary, this is a really helpful guide for women during menopause and for those wanting to make changes to their lifestyle to ensure that the next stage of their life is as healthy and fulfilling as possible. I was happy to see that environmental factors and how they can impact hormones feature in this book and for the inclusion of the 10 health recommendations from the World Cancer Research Fund. Final Comment: The Menopause Maze is so much more than a menopause book’ (Julieann Roberts, Editor, Menopause Health Matters)

‘I would recommend this as a “must have” single text that covers conventional, complementary and self-help options…….. What to do can be so confusing – and so little time to have a proper discussion within a 10-minute GP slot. The book details the risks and benefits of HRT and bioidentical HRT and all the scientific references that will allow a woman to make informed choices. The authors of the book have written an excellent, easy to read and understand guide that examines alternatives other than conventional HRT. A by product is how to reduce the risk of heart disease and osteoporosis using nutrition as well as HRT. It has already been well received by a couple of Body in Balance Clinic clients experiencing very different issues, and wanting to do more to help themselves through their body changes and ease their symptoms’ (Mariette Lobo, Body in Balance Training and Clinic, on her Facebook Page, 31 May 2016).

* Available on BBC iPlayer until 18th March 2017

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